A New Risk Classification System for Therapeutic Decision Making with Intermediate-risk Prostate Cancer Patients Undergoing Dose-escalated External-beam Radiation Therapy

One is the new six: The International Society of Urological Pathology (ISUP) patient-focused approach to Gleason grading

“…These two categories have long been known to have different prognostic significance and in fact, Gleason scores 7 (3 + 4) and 7 (4 + 3) have been incorporated into nomograms and risk calculators for many years. [26][27][28] Subsequent to the 2014 consensus meeting, it was decided by the ISUP working group that the percentage pattern 4 should be documented in all Gleason 7 tumours, with agreement for this decision being obtained from participants by web-polling. The documentation of percentage pattern 4 is particularly important in ISUP grade 2 cancers, as the active surveillance guideline published by Cancer Care Ontario and subsequently endorsed by the American Society of Clinical Oncology, indicates that selected patients with Gleason 7 tumours who have ≤10% pattern 4 tumour, can be considered for active surveillance protocols.…”

Imaging and Pathology Correlations for Different Risk Stratification Models for Intermediate-risk Prostate Cancer

“…As noted in the MSKCC study sub-stratifying intermediate-risk men into favorable and unfavorable subgroups, a difference in 8-year PCSM of 0.8% vs. 4.2%, respectively, was seen in patients treated with dose-escalated external beam radiotherapy (2). However, a recent report in a cohort that underwent brachytherapy demonstrated a smaller difference with 15-year PCSM of 0.6% for favorable and 2.2% for unfavorable intermediate-risk men (19).…”

“…This is particularly true for men with intermediate-risk prostate cancer, where so-called favorable-intermediate prostate cancer behaves similarly to low-risk disease with regards to prostate cancer-specific mortality (PCSM), while unfavorable-intermediate risk more closely follows high-risk disease (2,3).…”

“…The Memorial Sloan Kettering Cancer Center (MSKCC) model (Table I) proposes to divide the intermediate group into "favorable" and "unfavorable" categories (2). Men with a biopsy Gleason score (GS) of ≤ 3+4 and less than 50% of biopsy cores positive are classified as having favorable intermediate-risk disease.…”

What’s new in prostate cancer research?

“…A new sub-classification was recently proposed, whereby "unfavourable intermediate-risk" (UIR) prostate cancer was defined as any intermediate-risk prostate cancer with a primary Gleason pattern of 4, a percentage of positive biopsy cores higher than 50%, or more than one intermediate risk factor (cT2b-c, PSA 10-20 ng/mL or Gleason score 7). 2 (Fig. 1).…”